Deep Plane vs SMAS Face Lift: Techniques, Recovery and Cost in Australia

Quick answer: Both techniques lift the same deep support layer of the face, the SMAS. The difference is how the surgeon releases it. A SMAS face lift tightens or repositions that layer while leaving the overlying skin and fat attached to it, and a deep plane face lift releases the retaining ligaments beneath the SMAS so the SMAS, fat and skin move together as one unit. In practice a deep plane technique tends to give more movement in the midface and jawline, takes longer in theatre, and therefore usually sits at a higher total cost. Neither is universally the correct choice, and technique is matched to your anatomy rather than to a trend.

What is the SMAS, and why does every face lift technique refer to it?

The SMAS, or superficial musculoaponeurotic system, is a fibrous sheet that sits between the skin and the deeper facial muscles. It is continuous with the platysma in the neck. When people describe a face lift as “lifting the muscle rather than the skin”, the SMAS is the layer they mean.

This matters commercially as well as clinically, because almost every face lift marketed in Australia is a SMAS-based operation of some kind. The variation is in how far the surgeon goes: whether the SMAS is folded, tightened, partially cut and repositioned, or fully released from the ligaments that anchor it to the facial skeleton.

How does a SMAS face lift work?

In a SMAS face lift, the skin is elevated off the SMAS, and the SMAS is then addressed separately. Depending on the variation the surgeon may plicate it (fold and stitch it on itself), imbricate it (overlap it), or excise a strip and advance it. The skin is then redraped and any excess trimmed.

Because the skin and the SMAS are handled as two separate layers pulling in two directions, the surgeon has independent control over each. That is a real advantage in some faces. The trade-off is that the deeper retaining ligaments are largely left intact, so the amount of movement available in the midface is limited by those ligaments.

Variations you may hear named include the extended SMAS, the SMASectomy, and the short scar or mini lift. Our article on the differences between a mini and a full face lift covers where the shorter operations do and do not apply.

How does a deep plane face lift differ?

A deep plane face lift enters beneath the SMAS and releases the retaining ligaments directly, including the zygomatic and masseteric ligaments. The skin, fat and SMAS then move as a single composite flap.

Two consequences follow. First, because the layers are not separated from one another, the blood supply to the skin flap is generally better preserved, which is one reason the technique is often discussed in the context of patients with more compromised healing. Second, because the ligaments are released rather than pulled against, repositioning of the midface and jowl can be achieved with less tension on the skin.

Less tension on the skin is the reason deep plane work is associated with a less operated appearance, though appearance depends heavily on surgical judgement and on your starting anatomy, not on the technique label alone. You can read more on the advantages of a deep plane face lift, and on how face lift techniques have evolved.

Which technique is better for jowls and midface volume loss?

Jowling and midface flattening are usually driven by descent and deflation of deep fat compartments over the cheekbone and along the jaw, combined with laxity in the SMAS and skin. Because a deep plane release frees the ligaments that hold the midface down, it generally offers more vertical repositioning of that segment.

That does not make it the answer in every case. Where the dominant issue is skin laxity with a well supported midface, or where a patient has had previous surgery in the area, a SMAS-based approach may be the more appropriate operation. Where neck banding is the main complaint, the neck component of the procedure may matter more than the face component, which is covered in platysmaplasty neck surgery explained.

Is recovery longer after a deep plane face lift?

Recovery from both procedures follows a broadly similar arc. Swelling and bruising are expected, peak in the first few days, and settle progressively over the following weeks. Deep plane dissection is more extensive, so some patients experience swelling that takes longer to resolve, and numbness over the cheek is common while sensory nerves recover.

Both operations carry real risks. These include bleeding and haematoma, infection, delayed wound healing, unfavourable scarring, asymmetry, temporary or permanent injury to branches of the facial nerve, changes in sensation, hair loss around the incisions, and the risks associated with general anaesthesia. Smoking materially increases the risk of wound healing problems. Revision surgery is sometimes required. A realistic week by week account is set out in our guide to face lift recovery week by week.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

What is the cost difference between a deep plane and a SMAS face lift in Australia?

Deep plane surgery generally costs more than a standard SMAS procedure. The reason is not marketing, it is theatre time. A more extensive dissection takes longer, which increases both the surgeon’s fee and the anaesthetic and hospital facility fees that are charged by the hour or by theatre banding.

Your total is made up of four separate items, and a quote that does not itemise all four is not a comparable quote:

• Surgeon’s fee
• Anaesthetist’s fee
• Hospital or day facility fee
• Follow up care, garments and any revision policy

Purely cosmetic face lift surgery does not attract a Medicare rebate, and private health funds generally do not contribute where there is no Medicare item number. Where a procedure has a functional component, eligibility is assessed case by case against the relevant criteria, and eligibility cannot be assumed from a website.

Current fee ranges for each technique are set out on our page covering what a face lift costs in Australia and on the pricing page.

How do I know which technique I actually need?

You will not be able to determine this from a website, and you should be cautious of any clinic that names your technique before examining you. The assessment involves your skin quality, the degree and pattern of descent, your facial skeleton, your neck, previous surgery, medical history, smoking status and what you want changed.

A useful test of a consultation is whether the surgeon explains why a technique suits your face specifically, and what the alternatives would achieve. Our article on questions to ask before a face lift sets out what to bring.

Frequently asked questions

Is a deep plane face lift more effective than a SMAS face lift?

It offers greater repositioning of the midface and jawline because the retaining ligaments are released. Whether that produces a better result for you depends on your anatomy. Neither technique produces a guaranteed outcome and results vary between individuals.

Does a deep plane face lift last longer?

Longevity is influenced by technique, but also by age at surgery, skin quality, genetics, sun exposure and smoking. Ageing continues after any face lift. See long term face lift results for a fuller discussion.

Are the scars different between the two techniques?

The incision pattern is broadly similar, typically around the ear and into the hairline. Scar quality depends on healing, tension and aftercare rather than on the depth of dissection alone.

Can I have a deep plane face lift if I have had a previous face lift?

Sometimes, but previous surgery alters the tissue planes and increases technical difficulty. This is assessed individually.

Does Medicare cover either procedure?

Purely cosmetic face lift surgery is not covered. Where a functional indication exists, eligibility is assessed against the relevant criteria at consultation.

Discuss which technique suits your face

Technique selection is a clinical decision made in person, not online. To discuss deep plane and SMAS options for your face, and to receive an itemised quote covering surgeon, anaesthetist and hospital fees, you can book a consultation or contact the practice.